2,445 results on '"Miravitlles, Marc"'
Search Results
202. Efficacy of anti-inflammatory or antibiotic treatment in patients with non-complicated acute bronchitis and discoloured sputum: randomised placebo controlled trial
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Llor, Carl, Moragas, Ana, Bayona, Carolina, Morros, Rosa, Pera, Helena, Plana-Ripoll, Oleguer, Cots, Josep M, and Miravitlles, Marc
- Published
- 2013
203. Distribution of alpha1 antitrypsin rare alleles in six countries: Results from the Progenika diagnostic network.
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Lopez-Campos, José Luis, Rapun, Noelia, Czischke, Karen, Jardim, José R., Acquier, Mariano Fernandez, Munive, Abraham Ali, Günen, Hakan, Drobnic, Estrella, Miravitlles, Marc, and Osaba, Lourdes
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Background: Knowledge of the frequency of rare SERPINA1 mutations could help in the management of alpha1 antitrypsin deficiency (AATD). The present study aims to assess the frequencies of rare and null alleles and their respiratory and hepatic pathogenicity. Methods: This is a secondary analysis of a study that evaluated the viability of the Progenika diagnostic genotyping system in six different countries by analyzing 30,827 samples from cases of suspected AATD. Allele-specific genotyping was carried out with the Progenika A1AT Genotyping Test which analyses 14 mutations in buccal swabs or dried blood spots samples. SERPINA1 gene sequencing was performed for serum AAT-genotype discrepancies or by request of the clinician. Only cases with rare mutations were included in this analysis. Results: There were 818 cases (2.6%) carrying a rare allele, excluding newly identified mutations. All were heterozygous except for 20 that were homozygous. The most frequent alleles were the M-like alleles, PI*M
malton and PI*Mheerlen . Of the 14 mutations included in the Progenika panel, there were no cases detected of PI*Siiyama , PI*Q0granite falls and PI*Q0west . Other alleles not included in the 14-mutation panel and identified by gene sequencing included PI*Mwürzburg , PI*Zbristol , and PI*Zwrexham , and the null alleles PI*Q0porto , PI*Q0madrid , PI*Q0brescia , and PI*Q0kayseri . Conclusions: The Progenika diagnostic network has allowed the identification of several rare alleles, some unexpected and not included in the initial diagnostic panel. This establishes a new perspective on the distribution of these alleles in different countries. These findings may help prioritize allele selection for routine testing and highlights the need for further research into their pathogenetic role. [ABSTRACT FROM AUTHOR]- Published
- 2023
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204. Population-based study of LAMA monotherapy effectiveness compared with LABA/LAMA as initial treatment for COPD in primary care
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Barrecheguren, Miriam, Monteagudo, Mónica, and Miravitlles, Marc
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- 2018
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205. What have we learned from observational studies and clinical trials of mild to moderate COPD?
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Barrecheguren, Miriam, González, Cruz, and Miravitlles, Marc
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- 2018
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206. Alpha-1 antitrypsin deficiency: outstanding questions and future directions
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Torres-Durán, María, Lopez-Campos, José Luis, Barrecheguren, Miriam, Miravitlles, Marc, Martinez-Delgado, Beatriz, Castillo, Silvia, Escribano, Amparo, Baloira, Adolfo, Navarro-Garcia, María Mercedes, Pellicer, Daniel, Bañuls, Lucía, Magallón, María, Casas, Francisco, and Dasí, Francisco
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- 2018
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207. Large-scale external validation and comparison of prognostic models: an application to chronic obstructive pulmonary disease
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Guerra, Beniamino, Haile, Sarah R., Lamprecht, Bernd, Ramírez, Ana S., Martinez-Camblor, Pablo, Kaiser, Bernhard, Alfageme, Inmaculada, Almagro, Pere, Casanova, Ciro, Esteban-González, Cristóbal, Soler-Cataluña, Juan J., de-Torres, Juan P., Miravitlles, Marc, Celli, Bartolome R., Marin, Jose M., ter Riet, Gerben, Sobradillo, Patricia, Lange, Peter, Garcia-Aymerich, Judith, Antó, Josep M., Turner, Alice M., Han, Meilan K., Langhammer, Arnulf, Leivseth, Linda, Bakke, Per, Johannessen, Ane, Oga, Toru, Cosio, Borja, Ancochea-Bermúdez, Julio, Echazarreta, Andres, Roche, Nicolas, Burgel, Pierre-Régis, Sin, Don D., Soriano, Joan B., Puhan, Milo A., and for the 3CIA collaboration
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- 2018
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208. Factors associated with depression in COPD: A multicenter study
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Martinez Rivera, Carlos, Costan Galicia, Joaquin, Alcazar Navarrete, Bernardino, Garcia-Polo, Cayo, Ruiz Iturriaga, Luis Alberto, Herrejon, Alberto, Ros Lucas, Jose Antonio, Garcia-Sidro, Patricia, Tirado-Conde, Gema, Lopez-Campos, Jose Luis, Mayoralas Alises, Sagrario, de Miguel-Diez, Javier, Esquinas, Cristina, and Miravitlles, Marc
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Depression (Mood disorder) -- Research -- Risk factors ,Chronic obstructive lung disease -- Research -- Complications and side effects -- Prognosis ,Health - Abstract
Introduction Depression is a prevalent comorbidity in COPD and has an impact on the prognosis of these patients, thereby making it important to study the factors associated with depression in patients with COPD. Method A multicenter, observational and cross-sectional study was conducted to study the factors associated with depression in patients with COPD measured by the hospital anxiety and depression (HAD) questionnaire. We analyzed anthropometric variables and the number of exacerbations in the previous year and calculated the 6-min walking test and the body mass index, airflow obstruction, dyspnea, and exercise (BODE) index. All the patients completed the quality of life EQ-5D and the LCADL physical activity questionnaires. The relationship of these variables with depression was evaluated with two multiple logistic regression models. Results One hundred fifteen patients were evaluated (93 % male) with a mean age of 66.9 years (SD 8.8) and a mean FEV1 % of 44.4 % (SD 15.7 %). 24.3 % presented symptoms of depression (HAD-D > 8). These latter patients had worse lung function, greater dyspnea, reduced exercise capacity, a higher score in the BODE index, poorer quality of life, reduced physical activity, and more exacerbations. In the first logistic regression model, quality of life and the BODE index were associated with depression (AUC: 0.84; 0.74-0.94). In the second model including the variables in the BODE index, quality of life and dyspnea measured with the MRC scale (AUC: 0.87; 0.79-0.95) were associated with depression. Conclusions Nearly one-quarter of the patients with COPD in this study presented clinically significant depression associated with worse quality of life, reduced exercise capacity, greater dyspnea, and a higher score in the BODE index., Author(s): Carlos Martinez Rivera[sup.1] , Joaquin Costan Galicia[sup.2] , Bernardino Alcazar Navarrete[sup.3] , Cayo Garcia-Polo[sup.4] , Luis Alberto Ruiz Iturriaga[sup.5] , Alberto Herrejon[sup.6] , Jose Antonio Ros Lucas[sup.7] , Patricia [...]
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- 2016
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209. Muscular Dysfunction in COPD: Systemic Effect or Deconditioning?
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Pleguezuelos, Eulogio, Esquinas, Cristina, Moreno, Eva, Guirao, Lluis, Ortiz, Javier, Garcia-Alsina, Joan, Meri, Alex, and Miravitlles, Marc
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Chronic obstructive lung disease -- Research -- Care and treatment -- Complications and side effects -- Patient outcomes ,Health - Abstract
Background Muscular dysfunction has been described as one of the systemic manifestations of chronic obstructive pulmonary disease (COPD). Objective The aim of this study was to evaluate muscular strength of the different anatomical compartments in patients with severe COPD compared with healthy controls. Method We performed a cross-sectional study in patients with severe COPD. We evaluated the muscular strength of the respiratory muscles, flexors and extensors of the cervical spine and knee, as well as handgrip force. The 6-min walking test (6MWT) and serum inflammatory markers were also analysed. Results Twenty-eight male patients with COPD (mean age 67.8 years, mean FEV1 (%) 39 %) and 24 male healthy controls (mean age 70.2 years) were studied. The strength of the flexors and extensors of the knee was significantly reduced in patients with COPD (p < 0.001 and p = 0.003). No differences were observed in the flexors and extensors of the cervical spine and handgrip force between groups. No correlation was observed between the muscular strength in the different anatomic compartments and the concentrations of blood inflammatory biomarkers or the metres walked in the 6MWT in COPD patients. However, a significant negative linear correlation was observed between the 6MWT and IL-6 and IL-8 levels (rho = -0.67, p = 0.001; rho = -0.57, p = 0.008). In addition, we found a negative correlation between the 6MWT and inspiratory capacity (rho = -0.755, p = 0.031). Conclusions Our results suggest that muscular dysfunction in patients with COPD differs in different muscular compartments. The main factor for a reduced exercise capacity was a reduction in inspiratory capacity., Author(s): Eulogio Pleguezuelos[sup.1] [sup.2] [sup.3] , Cristina Esquinas[sup.4] , Eva Moreno[sup.5] , Lluis Guirao[sup.1] , Javier Ortiz[sup.6] , Joan Garcia-Alsina[sup.6] , Alex Meri[sup.2] [sup.3] , Marc Miravitlles[sup.4] Author Affiliations: (1) [...]
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- 2016
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210. Improving physical activity in patients with COPD with urban walking circuits
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Pleguezuelos, Eulogio, Pérez, María Engracia, Guirao, Lluís, Samitier, Beatriz, Ortega, Pilar, Vila, Xavier, Solans, Margarita, Riera, Ariadna, Moreno, Eva, Merí, Alex, and Miravitlles, Marc
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- 2013
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211. Differences between physician and patient in the perception of symptoms and their severity in COPD
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Miravitlles, Marc, Ferrer, Jaume, Baró, Eva, Lleonart, Marta, and Galera, Jordi
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- 2013
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212. Etiotypes in COPD: a pro/con debate
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Agusti, Alvar and Miravitlles, Marc
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- 2024
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213. Social Determinants of Respiratory Health: Opening the Door
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Perpiñá-Tordera, Miguel, Almonacid, Carlos, Vives, Eusebi Chiner, Moragón, Eva Martínez, Miravitlles, Marc, Falcón, Auxiliadora Romero, Soriano, Joan B., and Landa, Isabel Urrutia
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- 2024
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214. Alpha-1 antitrypsin (AAT) augmentation therapy and liver phenotype in individuals with homozygous Pi*Z AAT mutation (Pi*ZZ genotype)
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Fromme, Malin, primary, Hamesch, Karim, additional, Schneider, Carolin Victoria, additional, Mandorfer, Mattias, additional, Thorhauge, Katrine, additional, Pereira, Vítor, additional, Pons, Monica, additional, Reichert, Matthias, additional, Amzou, Samira, additional, Bals, Robert, additional, Koczulla, Andreas Rembert, additional, Miravitlles, Marc, additional, Janciauskiene, Sabina, additional, Genesca, Joan, additional, Benini, Federica, additional, Chorostowska-Wynimko, Joanna, additional, Griffiths, Bill, additional, Aigner, Elmar, additional, Teumer, Alexander, additional, Trauner, Michael, additional, Krag, Aleksander, additional, Trautwein, Christian, additional, and Strnad, Pavel, additional
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- 2022
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215. Pulmonologists’ Opinion on the Use of Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease Patients in Spain: A Cross-Sectional Survey
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Miravitlles, Marc, primary, González-Torralba, Fernando, additional, Represas-Represas, Cristina, additional, Pomares, Xavier, additional, Márquez-Martín, Eduardo, additional, González, Cruz, additional, Amado, Carlos, additional, Forné, Carles, additional, Alonso, Soledad, additional, Alcázar, Bernardino, additional, Barrecheguren, Miriam, additional, Jurado Mirete, Juan María, additional, and Naval, Elsa, additional
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- 2022
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216. Prevalence and Impact of Comorbidities in Individuals with Chronic Obstructive Pulmonary Disease: A Systematic Review
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Santos, Natasha Cordeiro dos, primary, Miravitlles, Marc, additional, Camelier, Aquiles Assunção, additional, Almeida, Victor Durier Cavalcanti de, additional, Maciel, Roberto Rodrigues Bandeira Tosta, additional, and Camelier, Fernanda Warken Rosa, additional
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- 2022
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217. Demographic and clinical characteristics of patients with α1-antitrypsin deficiency genotypes PI*ZZ and PI*SZ in the Spanish registry of EARCO
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Torres-Durán, María, primary, López-Campos, José Luis, additional, Rodríguez-Hermosa, Juan Luis, additional, Esquinas, Cristina, additional, Martínez-González, Cristina, additional, Hernández-Pérez, José María, additional, Rodríguez, Carlota, additional, Bustamante, Ana, additional, Casas-Maldonado, Francisco, additional, Barrecheguren, Miriam, additional, González, Cruz, additional, and Miravitlles, Marc, additional
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- 2022
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218. Determinants in the Underdiagnosis of COPD in Spain—CONOCEPOC Study
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Calle Rubio, Myriam, primary, Rodríguez Hermosa, Juan Luis, additional, Miravitlles, Marc, additional, and López-Campos, José Luis, additional
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- 2022
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219. Frequency and Associated Factors of Suicidal Ideation in Patients with Chronic Obstructive Pulmonary Disease
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Roncero, Carlos, primary, Pérez, Joselín, additional, Molina, Jesús, additional, Quintano, José Antonio, additional, Campuzano, Ana Isabel, additional, Pérez, Javier, additional, and Miravitlles, Marc, additional
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- 2022
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220. Diaphragmatic Movement at Rest and After Exertion: A Non-Invasive and Easy to Obtain Prognostic Marker in COPD
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Mekov, Evgeni, primary, Yanev, Nikolay, additional, Kurtelova, Nedelina, additional, Mihalova, Teodora, additional, Tsakova, Adelina, additional, Yamakova, Yordanka, additional, Miravitlles, Marc, additional, and Petkov, Rosen, additional
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- 2022
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221. Factors associated with changes in quality of life of COPD patients: A prospective study in primary care
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Monteagudo, Mònica, Rodríguez-Blanco, Teresa, Llagostera, Maria, Valero, Carles, Bayona, Xavier, Ferrer, Montserrat, and Miravitlles, Marc
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- 2013
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222. Characterisation of the overlap COPD–asthma phenotype. Focus on physical activity and health status
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Miravitlles, Marc, Soriano, Joan B., Ancochea, Julio, Muñoz, Luis, Duran-Tauleria, Enric, Sánchez, Guadalupe, Sobradillo, Víctor, and García-Río, Francisco
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- 2013
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223. Underdiagnosis of Chronic Obstructive Pulmonary Disease in Women: Quantification of the Problem, Determinants and Proposed Actions
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Ancochea, Julio, Miravitlles, Marc, García-Río, Francisco, Muñoz, Luis, Sánchez, Guadalupe, Sobradillo, Víctor, Duran-Tauleria, Enric, and Soriano, Joan B.
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- 2013
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224. Quality and Strength: The GRADE System for Formulating Recommendations in Clinical Practice Guidelines
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Alonso-Coello, Pablo, Rigau, David, Sanabria, Andrea Juliana, Plaza, Vicente, Miravitlles, Marc, and Martinez, Laura
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- 2013
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225. Infradiagnóstico de la enfermedad pulmonar obstructiva crónica en mujeres: cuantificación del problema, determinantes y propuestas de acción
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Ancochea, Julio, Miravitlles, Marc, García-Río, Francisco, Muñoz, Luis, Sánchez, Guadalupe, Sobradillo, Víctor, Duran-Tauleria, Enric, and Soriano, Joan B.
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- 2013
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226. Calidad y fuerza: el sistema GRADE para la formulación de recomendaciones en las guías de práctica clínica
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Alonso-Coello, Pablo, Rigau, David, Sanabria, Andrea Juliana, Plaza, Vicente, Miravitlles, Marc, and Martinez, Laura
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- 2013
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227. A study of adherence to antibiotic treatment in ambulatory respiratory infections
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Llor, Carl, Hernández, Silvia, Bayona, Carolina, Moragas, Ana, Sierra, Nuria, Hernández, Marta, and Miravitlles, Marc
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- 2013
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228. Chronic bronchial infection in COPD. Is there an infective phenotype?
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Matkovic, Zinka and Miravitlles, Marc
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- 2013
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229. Spanish COPD Guideline (GesEPOC) Update: Comorbidities, Self-Management and Palliative Care
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López-Campos, J. L., Almagro, Pere, Gómez, José Tomás, Chiner, Eusebi, Palacios, Leopoldo, Hernández, Carme, Navarro, M. Dolores, Molina, Jesús, Rigau, David, Soler-Cataluña, Juan José, Calle, Myriam, Cosío, Borja G., Casanova, Ciro, and Miravitlles, Marc
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GesEPOC ,Opioids ,Atención integrada ,Automanejo ,Self-management ,Palliative care ,Opiáceo ,COPD ,Integrated care ,EPOC ,Cuidados paliativos ,Comorbidities ,Comorbilidades - Abstract
[EN]: The current health care models described in GesEPOC indicate the best way to make a correct diagnosis, the categorization of patients, the appropriate selection of the therapeutic strategy and the management and prevention of exacerbations. In addition, COPD involves several aspects that are crucial in an integrated approach to the health care of these patients. The evaluation of comorbidities in COPD patients represents a healthcare challenge. As part of a comprehensive assessment, the presence of comorbidities related to the clinical presentation, to some diagnostic technique or to some COPD-related treatments should be studied. Likewise, interventions on healthy lifestyle habits, adherence to complex treatments, developing skills to recognize the signs and symptoms of exacerbation, knowing what to do to prevent them and treat them within the framework of a self-management plan are also necessary. Finally, palliative care is one of the pillars in the comprehensive treatment of the COPD patient, seeking to prevent or treat the symptoms of a disease, the side effects of treatment, and the physical, psychological and social problems of patients and their caregivers. Therefore, the main objective of this palliative care is not to prolong life expectancy, but to improve its quality. This chapter of GesEPOC 2021 presents an update on the most important comorbidities, self-management strategies, and palliative care in COPD, and includes a recommendation on the use of opioids for the treatment of refractory dyspnea in COPD., [ES]: Los modelos de atención sanitaria actuales descritos en GesEPOC indican la mejor manera de hacer un diagnóstico correcto, la categorización de los pacientes, la adecuada selección de la estrategia terapéutica y el manejo y la prevención de las agudizaciones. Además, en la EPOC concurren diversos aspectos que resultan cruciales en una aproximación integrada de la atención sanitaria a estos pacientes. La evaluación de las comorbilidades en el paciente con EPOC representa un reto asistencial. Dentro de una valoración integral debe estudiarse la presencia de comorbilidades que tengan relación con la presentación clínica, con alguna técnica diagnóstica o con algunos tratamientos relacionados con la EPOC. Asimismo, son necesarias intervenciones en hábitos de vida saludables, la adhesión a tratamientos complejos, desarrollar capacidades para poder reconocer los signos y síntomas de la exacerbación, saber qué hacer para prevenirlos y tratarlos enmarcados en un plan de automanejo. Finalmente, los cuidados paliativos constituyen uno de los pilares en el tratamiento integral del paciente con EPOC, con los que se buscan prevenir o tratar los síntomas de una enfermedad, los efectos secundarios del tratamiento, y los problemas físicos, psicológicos y sociales de los pacientes y sus cuidadores. Por tanto, el objetivo principal de estos cuidados paliativos no es prolongar la esperanza de vida, sino mejorar su calidad. En este capítulo de GesEPOC 2021 se presenta una actualización sobre las comorbilidades más importantes, las estrategias de automanejo y los cuidados paliativos en la EPOC, y se incluye una recomendación sobre el uso de opiáceos para el tratamiento de la disnea refractaria en la EPOC.
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- 2022
230. CONQUEST: A Quality Improvement Program for Defining and Optimizing Standards of Care for Modifiable High-Risk COPD Patients
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Alves,Luis, Pullen,Rachel, Hurst,John R, Miravitlles,Marc, Carter,Victoria, Chen,Rongchang, Couper,Amy, Dransfield,Mark, Evans,Alexander, Hardjojo,Antony, Jones,David, Jones,Rupert, Kerr,Margee, Kostikas,Konstantinos, Marshall,Jonathan, Martinez,Fernando, van Melle,Marije, Murray,Ruth, Muro,Shigeo, Nordon,Clementine, Pollack,Michael, Price,Chris, Sharma,Anita, Singh,Dave, Winders,Tonya, and Price,David B
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Patient Related Outcome Measures - Abstract
Luis Alves,1 Rachel Pullen,2 John R Hurst,3 Marc Miravitlles,4 Victoria Carter,5 Rongchang Chen,6 Amy Couper,2 Mark Dransfield,7 Alexander Evans,5 Antony Hardjojo,2 David Jones,5 Rupert Jones,8 Margee Kerr,5 Konstantinos Kostikas,9 Jonathan Marshall,10 Fernando Martinez,11 Marije van Melle,5 Ruth Murray,5 Shigeo Muro,12 Clementine Nordon,10 Michael Pollack,13 Chris Price,5 Anita Sharma,14 Dave Singh,15 Tonya Winders,16 David B Price2 1EPIUnit - Epidemiology Research Unit, ITR - Laboratory for Integrative and Translational Research in Population Health, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal; 2Observational and Pragmatic Research Institute, Singapore, Singapore; 3UCL Respiratory, University College London, London, UK; 4Pneumology Dept, Hospital Universitari Vall dâHebron, Vall dâHebron Institut de Recerca (VHIR), Vall dâHebron Barcelona Hospital Campus, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain; 5Optimum Patient Care, Cambridge, UK; 6Key Laboratory of Respiratory Disease of Shenzhen, Shenzhen Institute of Respiratory Disease, Shenzhen Peopleâs Hospital (Second Affiliated Hospital of Jinan University, First Affiliated Hospital of South University of Science and Technology of China), Shenzhen, Guangdong, Peopleâs Republic of China; 7Division of Pulmonary, Allergy, and Critical Care Medicine, Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA; 8Research and Knowledge Exchange, Plymouth Marjon University, Plymouth, UK; 9Respiratory Medicine Department, University of Ioannina School of Medicine, Ioannina, Greece; 10BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK; 11New York-Presbyterian Weill Cornell Medical Center, New York, NY, USA; 12Department of Respiratory Medicine, Nara Medical University, Nara, Japan; 13BioPharmaceuticals Medical, AstraZeneca, Wilmington, DE, USA; 14Platinum Medical Centre, Chermside, QLD, Australia; 15Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, UK; 16USA & Global Allergy & Airways Patient Platform, Vienna, AustriaCorrespondence: David B Price, Observational and Pragmatic Research Institute, 22 Sin Ming Lane, #06-76, Midview City, 573969, Singapore, Tel +65 3105 1489, Email dprice@opri.sgAbstract: The COllaboration on QUality improvement initiative for achieving Excellence in STandards of COPD care (CONQUEST) aims to improve the quality of COPD care in primary care. The CONQUEST target population includes patients diagnosed with COPD, and those undiagnosed but with COPD-like exacerbations, who are at high but modifiable risk of COPD exacerbations, increased morbidity, and mortality. Timely diagnosis and optimized management to reduce these risks is vital. There is a need for a quality improvement program (QIP) that enables long-term improvement of patient clinical outcomes via integration of the program into routine clinical care. Core to the CONQUEST program is the adoption of four specifically designed, globally applicable, and expert-agreed quality standards (QS) for modifiable high-risk COPD patients. Translation of the QS into clinical practice, and implementation of the QIP, is guided by the CONQUEST global operational protocol provided to sites meeting the minimum healthcare system requirements. Initial analyses of current practices are conducted to generate baseline assessments of need within healthcare systems and sites looking to implement the QIP. Implementation is supported by the provision of CONQUEST resources and tools, such as clinical decision support, that promote prompt identification and treatment of patients. Utilization of electronic medical record (EMR) and patient-reported data are integral components of the QIP. Regular, automated collection and analysis of data, combined with a cyclical review of the implementation process, will be conducted for long-term, continuous improvement and health impact evaluation. The CONQUEST QIP will be an important resource in the identification and management of patients with modifiable high-risk COPD. Embedding the CONQUEST QS into routine clinical practice with regular evaluation and feedback will result in long-term quality of care improvement.Keywords: patient-reported outcome, patient-reported information, clinical decision support, primary care, quality standards, integrated care
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- 2022
231. Spanish COPD Guidelines (GesEPOC) 2021 Update Diagnosis and Treatment of COPD Exacerbation Syndrome
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Soler-Cataluña, Juan José, Piñera, Pascual, Trigueros, Juan Antonio, Calle, Myriam, Casanova, Ciro, Cosío, Borja G., López-Campos, J. L., Molina, Jesús, Almagro, Pere, Gómez, José Tomás, Riesco, Juan Antonio, Simonet, Pere, Rigau, David, Soriano, Joan B., Ancochea, Julio, and Miravitlles, Marc
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Agudización ,Rasgos tratables ,Enfermedad pulmonar obstructiva crónica ,COPD ,Exacerbation ,Syndrome ,Síndrome ,Treatable traits - Abstract
[ES] En este artículo se presentan las recomendaciones sobre el diagnóstico y tratamiento del síndrome de agudización de la enfermedad pulmonar obstructiva crónica (EPOC) (SAE) de GesEPOC 2021. Como principales novedades, la guía propone una definición y aproximación sindrómica, una nueva clasificación de gravedad y el reconocimiento de diferentes rasgos tratables (RT), lo que supone un nuevo paso hacia la medicina personalizada. La evaluación de la evidencia se realiza mediante la metodología Grading of Recommendations Assessment, Development and Evaluation (GRADE), con la incorporación de seis nuevas preguntas con enfoque paciente, intervención, comparación y resultados (PICO). El proceso diagnóstico comprende cuatro etapas: 1) establecer el diagnóstico del SAE, 2) valorar la gravedad del episodio, 3) identificar el factor desencadenante y 4) abordar los RT. En este proceso diagnóstico se diferencia una aproximación ambulatoria, en la que se recomienda incluir una batería básica de pruebas y una hospitalaria, más exhaustiva, en la que se contempla el estudio de diferentes biomarcadores y pruebas de imagen. El tratamiento broncodilatador destinado al alivio inmediato de los síntomas se considera esencial para todos los pacientes, mientras que el uso de antibióticos, corticoides sistémicos, oxigenoterapia, ventilación asistida o el tratamiento de las comorbilidades variará en función de la gravedad y de los posibles RT. El empleo de antibióticos estará especialmente indicado ante un cambio en el color del esputo, cuando se requiera asistencia ventilatoria, en los casos que cursen con neumonía y también para aquellos con proteína-C reactiva elevada (≥ 20 mg/L). Los corticoides sistémicos se recomiendan en el SAE que necesita ingreso y se sugieren en el SAE moderado. La eficacia de estos fármacos es mayor en pacientes con recuento de eosinófilos en sangre ≥ 300 células/mm3. La ventilación mecánica no invasiva en fase aguda se establece fundamentalmente para pacientes con SAE que cursen con acidosis respiratoria, a pesar del tratamiento inicial., [EN] This article details the GesEPOC 2021 recommendations on the diagnosis and treatment of COPD exacerbation syndrome (CES). The guidelines propose a definition-based syndromic approach, a new classification of severity, and the recognition of different treatable traits (TT), representing a new step toward personalized medicine. The evidence is evaluated using GRADE methodology, with the incorporation of 6 new PICO questions. The diagnostic process comprises four stages: 1) establish a diagnosis of CES, 2) assess the severity of the episode, 3) identify the trigger, and 4) address TTs. This diagnostic process differentiates an outpatient approach, that recommends the inclusion of a basic battery of tests, from a more comprehensive hospital approach, that includes the study of different biomarkers and imaging tests. Bronchodilator treatment for immediate relief of symptoms is considered essential for all patients, while the use of antibiotics, systemic corticosteroids, oxygen therapy, and assisted ventilation and the treatment of comorbidities will vary depending on severity and possible TTs. The use of antibiotics will be indicated particularly if sputum color changes, when ventilatory assistance is required, in cases involving pneumonia, and in patients with elevated C-reactive protein (≥ 20 mg/L). Systemic corticosteroids are recommended in CES that requires admission and are suggested in moderate CES. These drugs are more effective in patients with blood eosinophil counts ≥ 300 cells/mm3. Acute-phase non-invasive mechanical ventilation is specified primarily for patients with CES who develop respiratory acidosis despite initial treatment.
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- 2022
232. Determinants in the Underdiagnosis of COPD in Spain—CONOCEPOC Study
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Universidad de Sevilla. Departamento de Medicina, Calle Rubio, Myriam, Rodríguez Hermosa, Juan Luis, Miravitlles, Marc, Lopez-Campos Bodineau, Jose Luis, Universidad de Sevilla. Departamento de Medicina, Calle Rubio, Myriam, Rodríguez Hermosa, Juan Luis, Miravitlles, Marc, and Lopez-Campos Bodineau, Jose Luis
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Factors such as seeking medical attention for respiratory symptoms and health professionals ordering spirometry come into play in the underdiagnosis of chronic obstructive pulmonary disease (COPD). The objective of this study was to analyze seeking medical attention and the use of spirometry in individuals with chronic respiratory symptoms and to compare these results with those obtained in the 2005 and 2011 surveys. Material and Methods: A cross-sectional, observational, epidemiological study was conducted via phone interview in December 2020 in Spain, with a representative sample from 17 autonomous communities. The study design was identical to that of the studies carried out in 2005 and 2011 to evaluate the changes that have occurred in seeking medical attention and performing spirometry in Spain, as well as the variability between autonomous communities. Results: From 89,601 phone contacts, a total of 6534 respondents were obtained. A total of 24.8% reported having some chronic respiratory symptom, and 17.9% reported a respiratory disease. Only 51.6% of those who had some chronic respiratory symptom had seen their doctor, which was less likely among current smokers (OR: 0.599, 95% CI: 0.467–0.769, p < 0.001) and those living in a rural setting (OR: 0.797, 95% CI: 0.651–0.975, p = 0.027). A total of 68.7% of the individuals who saw a doctor reported having undergone spirometry, most frequently males (OR: 1.535, 95% CI: 2.074–1.136, p < 0.005), former smokers (OR: 1.696, 95% CI: 2.407–1.195, p < 0.003), and those seen by a pulmonologist (OR: 6.151, 95% CI: 8.869–4.265, p < 0.001). With respect to the 2005 survey, more frequent use of spirometry has been observed (42.6 vs. 68.7%), without any change in seeking medical attention for respiratory symptoms. There is a clear variability according to the autonomous community (p < 0.05). Conclusions: Many individuals with chronic respiratory symptoms do not seek medical attention and although the use of spirometry has inc
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- 2022
233. Feasibility of a genotyping system for the diagnosis of alpha1 antitrypsin defciency: a multinational cross‑sectional analysis
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Universidad de Sevilla. Departamento de Medicina, López-Campos Bodineau, José Luis, Osaba, Lourdes, Czischke, Karen, Jardim, José R., Fernandez Acquier, Mariano, Ali, Abraham, Günen, Hakan, Rapun, Noelia, Drobnic, Estrella, Miravitlles, Marc, Universidad de Sevilla. Departamento de Medicina, López-Campos Bodineau, José Luis, Osaba, Lourdes, Czischke, Karen, Jardim, José R., Fernandez Acquier, Mariano, Ali, Abraham, Günen, Hakan, Rapun, Noelia, Drobnic, Estrella, and Miravitlles, Marc
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Introduction: Currently, strategies for improving alpha1 antitrypsin defciency (AATD) diagnosis are needed. Here we report the performance of a multinational multiplex-based genotyping test on dried blood spots and buccal swabs sent by post or courier and with web registration for subjects with suspected AATD in Argentina, Brazil, Chile, Colom‑ bia, Spain, and Turkey. Methods: This was an observational, cross-sectional analysis of samples from patients with suspected AATD from March 2018 to January 2022. Samples were coded on a web platform and sent by post or courier to the central laboratory in Northern Spain. Allele-specifc genotyping for the 14 most common mutations was carried out with the A1AT Genotyping Test (Progenika-Grifols, Spain). SERPINA1 gene sequencing was performed if none of the muta‑ tions were found or one variant was detected in heterozygous status and the AAT serum level was<60 mg/dl, or if requested by the clinician in charge. Results: The study included 30,827 samples: 30,458 (94.7%) with fnal results after direct genotyping and 369 (1.1%) with additional gene sequencing. Only 0.3% of the samples were not processed due to their poor quality. The preva‑ lence of the most frequent allele combinations was MS 14.7%, MZ 8.6%, SS 1.9%, SZ 1.9%, and ZZ 0.9%. Additionally, 70 cases with new mutations were identifed. Family screening was conducted in 2.5% of the samples. Samples from patients with respiratory diseases other than COPD, including poorly controlled asthma or bronchiectasis, also pre‑ sented AATD mutations. Conclusions: Our results confrm the viability of this diagnostic system for genotyping AATD conducted simultane‑ ously in diferent countries. The system has proved satisfactory and can improve the timely diagnosis of AATD.
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- 2022
234. Additional file 1 of Feasibility of a genotyping system for the diagnosis of alpha1 antitrypsin deficiency: a multinational cross-sectional analysis
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Grifols, López-Campos, J. L., Osaba, Lourdes, Czischke, Karen, Jardim, José R., Fernández Acquier, Mariano, Ali, Abraham, Günen, Hakan, Rapun, Noelia, Drobnic, Estrella, Miravitlles, Marc, Grifols, López-Campos, J. L., Osaba, Lourdes, Czischke, Karen, Jardim, José R., Fernández Acquier, Mariano, Ali, Abraham, Günen, Hakan, Rapun, Noelia, Drobnic, Estrella, and Miravitlles, Marc
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Figure 1S. Evolution over time of genetic study requests in Spain, LATAM and Turkey. Figure 2S. Evolution over time of requests for genetic studies by LATAM countries. Figure 3S. Distribution of sample types by geographical area. Figure 4S. Time elapsed between different steps by geographical area. Figure 5S. Allele distribution according to the different genotyping reasons in different Latin American countries. Table 1S. Description of the allelic variants and associated alleles tested by A1AT Genotyping Test; Information about the activity of the A1AT protein expressed. Table 2S. Cases in which sequencing revealed additional mutation from direct genotyping.
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- 2022
235. Spanish COPD Guidelines (GesEPOC) 2021: Updated Pharmacological treatment of stable COPD
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Miravitlles, Marc, Calle Rubio, Myriam, Molina, Jesús, Almagro, Pere, Gómez, José Tomás, Trigueros, Juan Antonio, Cosío, Borja G., Casanova, Ciro, López-Campos, J. L., Riesco, Juan Antonio, Simonet, Pere, Rigau, David, Soriano, Joan B., Ancochea, Julio, Soler-Cataluña, Juan José, Miravitlles, Marc, Calle Rubio, Myriam, Molina, Jesús, Almagro, Pere, Gómez, José Tomás, Trigueros, Juan Antonio, Cosío, Borja G., Casanova, Ciro, López-Campos, J. L., Riesco, Juan Antonio, Simonet, Pere, Rigau, David, Soriano, Joan B., Ancochea, Julio, and Soler-Cataluña, Juan José
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The Spanish COPD Guidelines (GesEPOC) were first published in 2012, and since then have undergone a series of updates incorporating new evidence on the diagnosis and treatment of COPD. GesEPOC was drawn up in partnership with scientific societies involved in the treatment of COPD and the Spanish Patients' Forum. Their recommendations are based on an evaluation of the evidence using GRADE methodology, and a narrative description of the evidence in areas in which GRADE cannot be applied. In this article, we summarize the recommendations on the pharmacological treatment of stable COPD based on 9 PICO questions. COPD treatment is a 4-step process: 1) diagnosis, 2) determination of the risk level, 3) initial and subsequent inhaled therapy, and 4) identification and management of treatable traits. For the selection of inhaled therapy, high-risk patients are divided into 3 phenotypes: non-exacerbator, eosinophilic exacerbator, and non-eosinophilic exacerbator. Some treatable traits are general and should be investigated in all patients, such as smoking or inhalation technique, while others affect severe patients in particular, such as chronic hypoxemia and chronic bronchial infection. COPD treatment is based on long-acting bronchodilators with single agents or in combination, depending on the patient's risk level. Eosinophilic exacerbators must receive inhaled corticosteroids, while non-eosinophilic exacerbators require a more detailed evaluation to choose the best therapeutic option. The new GesEPOC also includes recommendations on the withdrawal of inhaled corticosteroids and on indications for alpha-1 antitrypsin treatment. GesEPOC offers a more individualized approach to COPD treatment tailored according to the clinical characteristics of patients and their level of complexity.
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- 2022
236. Feasibility of a genotyping system for the diagnosis of alpha1 antitrypsin deficiency: a multinational cross-sectional analysis
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Grifols, López-Campos, J. L., Osaba, Lourdes, Czischke, Karen, Jardim, José R., Fernández Acquier, Mariano, Ali, Abraham, Günen, Hakan, Rapun, Noelia, Drobnic, Estrella, Miravitlles, Marc, Grifols, López-Campos, J. L., Osaba, Lourdes, Czischke, Karen, Jardim, José R., Fernández Acquier, Mariano, Ali, Abraham, Günen, Hakan, Rapun, Noelia, Drobnic, Estrella, and Miravitlles, Marc
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[Introduction] Currently, strategies for improving alpha1 antitrypsin deficiency (AATD) diagnosis are needed. Here we report the performance of a multinational multiplex-based genotyping test on dried blood spots and buccal swabs sent by post or courier and with web registration for subjects with suspected AATD in Argentina, Brazil, Chile, Colombia, Spain, and Turkey., [Methods] This was an observational, cross-sectional analysis of samples from patients with suspected AATD from March 2018 to January 2022. Samples were coded on a web platform and sent by post or courier to the central laboratory in Northern Spain. Allele-specific genotyping for the 14 most common mutations was carried out with the A1AT Genotyping Test (Progenika-Grifols, Spain). SERPINA1 gene sequencing was performed if none of the mutations were found or one variant was detected in heterozygous status and the AAT serum level was < 60 mg/dl, or if requested by the clinician in charge., [Results] The study included 30,827 samples: 30,458 (94.7%) with final results after direct genotyping and 369 (1.1%) with additional gene sequencing. Only 0.3% of the samples were not processed due to their poor quality. The prevalence of the most frequent allele combinations was MS 14.7%, MZ 8.6%, SS 1.9%, SZ 1.9%, and ZZ 0.9%. Additionally, 70 cases with new mutations were identified. Family screening was conducted in 2.5% of the samples. Samples from patients with respiratory diseases other than COPD, including poorly controlled asthma or bronchiectasis, also presented AATD mutations., [Conclusions] Our results confirm the viability of this diagnostic system for genotyping AATD conducted simultaneously in different countries. The system has proved satisfactory and can improve the timely diagnosis of AATD.
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- 2022
237. Discriminant Validity of a Single Clinical Question for the Screening of Inactivity in Individuals Living with COPD
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Esteve, Ramón, María Antonia, Esteban, Cristóbal, Ortega-Ruiz, Francisco, Cebollero, Pilar, Carrascosa, Inés, Martínez-González, Cristina, Sobradillo, Patricia, Soler-Cataluña, Juan José, Miravitlles, Marc, García-Río, Francisco, Esteve, Ramón, María Antonia, Esteban, Cristóbal, Ortega-Ruiz, Francisco, Cebollero, Pilar, Carrascosa, Inés, Martínez-González, Cristina, Sobradillo, Patricia, Soler-Cataluña, Juan José, Miravitlles, Marc, and García-Río, Francisco
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[Introduction] Quantifying physical activity in chronic obstructive pulmonary disease (COPD) with questionnaires and activity monitors in clinical practice is challenging. The aim of the present study was to analyse the discriminant validity of a single clinical question for the screening of inactive individuals living with COPD., [Methods] A multicentre study was carried out in stable COPD individuals both in primary and tertiary care. Patients wore the Dynaport accelerometer for 8 days and then answered 5 physical activity questions developed for the study, referring to the week in which their physical activity was monitored. Receiver operating characteristic (ROC) curve analysis with physical activity level (PAL) as the gold standard reference was used to determine the best cut-off point for each of the 5 clinical physical activity questions tested., [Results] A total of 86 COPD participants were analysed (males 68.6%; mean (SD) age 66.6 (8.5) years; FEV1 50.9 (17.3)% predicted; mean of 7305 (3906) steps/day). Forty-two (48.8%) participants were considered physically inactive (PAL ≤ 1.69). Answers to 4 out of 5 questions significantly differed in active vs inactive patients. The Kappa index and ROC curves showed that the answer to the question “On average, how many minutes per day do you walk briskly?” had the best discriminative capacity for inactivity, with an area under the curve (AUC) (95% Confidence interval (CI)) of 0.73 (0.63– 0.84) and 30 min/day was identified as the best cut-off value (sensitivity (95% CI): 0.75 (0.60– 0.87); specificity: 0.76 (0.61– 0.88))., [Conclusion] The present results indicate that self-reported brisk walk time lower than 30 min/day may be a valid tool for the screening of inactivity in individuals living with COPD in routine care, if more detailed physical activity measures are not feasible.
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- 2022
238. Determinants in the Underdiagnosis of COPD in Spain-CONOCEPOC Study
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Sociedad Española de Neumología y Cirugía Torácica, GlaxoSmithKline, Calle Rubio, Myriam, Rodríguez Hermosa, Juan Luis, Miravitlles, Marc, López-Campos, J. L., Sociedad Española de Neumología y Cirugía Torácica, GlaxoSmithKline, Calle Rubio, Myriam, Rodríguez Hermosa, Juan Luis, Miravitlles, Marc, and López-Campos, J. L.
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Factors such as seeking medical attention for respiratory symptoms and health professionals ordering spirometry come into play in the underdiagnosis of chronic obstructive pulmonary disease (COPD). The objective of this study was to analyze seeking medical attention and the use of spirometry in individuals with chronic respiratory symptoms and to compare these results with those obtained in the 2005 and 2011 surveys. Material and Methods: A cross-sectional, observational, epidemiological study was conducted via phone interview in December 2020 in Spain, with a representative sample from 17 autonomous communities. The study design was identical to that of the studies carried out in 2005 and 2011 to evaluate the changes that have occurred in seeking medical attention and performing spirometry in Spain, as well as the variability between autonomous communities. Results: From 89,601 phone contacts, a total of 6534 respondents were obtained. A total of 24.8% reported having some chronic respiratory symptom, and 17.9% reported a respiratory disease. Only 51.6% of those who had some chronic respiratory symptom had seen their doctor, which was less likely among current smokers (OR: 0.599, 95% CI: 0.467–0.769, p < 0.001) and those living in a rural setting (OR: 0.797, 95% CI: 0.651–0.975, p = 0.027). A total of 68.7% of the individuals who saw a doctor reported having undergone spirometry, most frequently males (OR: 1.535, 95% CI: 2.074–1.136, p < 0.005), former smokers (OR: 1.696, 95% CI: 2.407–1.195, p < 0.003), and those seen by a pulmonologist (OR: 6.151, 95% CI: 8.869–4.265, p < 0.001). With respect to the 2005 survey, more frequent use of spirometry has been observed (42.6 vs. 68.7%), without any change in seeking medical attention for respiratory symptoms. There is a clear variability according to the autonomous community (p < 0.05). Conclusions: Many individuals with chronic respiratory symptoms do not seek medical attention and although the use of spirometry has inc
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- 2022
239. Discriminant Validity of a Single Clinical Question for the Screening of Inactivity in Individuals Living with COPD
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Ramon,Maria Antonia, Esteban,Cristóbal, Ortega,Francisco, Cebollero,Pilar, Carrascosa,Inés, Martinez-González,Cristina, Sobradillo,Patricia, Soler-Cataluña,Juan José, Miravitlles,Marc, GarcÃa-RÃo,Francisco, Ramon,Maria Antonia, Esteban,Cristóbal, Ortega,Francisco, Cebollero,Pilar, Carrascosa,Inés, Martinez-González,Cristina, Sobradillo,Patricia, Soler-Cataluña,Juan José, Miravitlles,Marc, and GarcÃa-RÃo,Francisco
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Maria Antonia Ramon,1 Cristóbal Esteban,2 Francisco Ortega,3 Pilar Cebollero,4 Inés Carrascosa,5 Cristina Martinez-González,6 Patricia Sobradillo,7 Juan José Soler-Cataluña,8 Marc Miravitlles,9 Francisco GarcÃa-RÃo10 1Pneumology Department, Hospital Universitari Vall d´Hebron/Vall dâHebron Institut de Recerca (VHIR), Vall dâHebron Barcelona Hospital Campus; Physical Therapy Department, Universitat Internacional de Catalunya and CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain; 2Respiratory Department, Hospital Galdakao; Health Services Research on Chronic Patients Network (REDISSEC) and BioCrues-Bizkaia Health Research Institute, Baracaldo, Spain; 3Pneumology Department, Hospital Universitario Virgen del RocÃo; Instituto de Biomedicina de Sevilla (IBiS), and CIBER de Enfermedades Respiratorias (CIBERES), Sevilla, Spain; 4Pneumology Department, Hospital CH de Navarra, Pamplona, Spain; 5Pneumology Department, Hospital Urduliz, Urduliz, Bizkaia, Spain; 6Pneumology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; 7Pneumology Department, Hospital de Cruces, Bilbao, Spain; 8Pneumology Department, Hospital Arnau de Vilanova-Lliria, Valencia, Spain; 9Pneumology Department, Hospital Universitari Vall d´Hebron/Vall dâHebron Institut de Recerca (VHIR), Vall dâHebron Barcelona Hospital Campus and CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain; 10Pneumology Department, Hospital Universitario La Paz-IdiPAZ, and CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, SpainCorrespondence: Marc Miravitlles, Pneumology Department, Hospital Universitari Vall d´Hebron/Vall dâHebron Institut de Recerca (VHIR), Vall d´Hebron Barcelona Hospital Campus, P. Vall dâHebron 119-129, Barcelona, 08035, Spain, Tel +34 934893000, Fax +34 93 274 82 08, Email marcm@separ.esIntroduction: Quantifying physical activity in chronic obstructive pulmonary disease (COPD) with questionnaires and activi
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- 2022
240. Biomarkers of Clot Activation and Degradation and Risk of Future Major Cardiovascular Events in Acute Exacerbation of COPD:A Cohort Sub-Study in a Randomized Trial Population
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Kamstrup, Peter, Sand, Jannie Marie Bulow, Ulrik, Charlotte Suppli, Janner, Julie, Ronn, Christian Philip, Ronnow, Sarah Rank, Leeming, Diana Julie, Jensen, Sidse Graff, Wilcke, Torgny, Mathioudakis, Alexander G., Miravitlles, Marc, Lapperre, Therese, Bendstrup, Elisabeth, Frikke-Schmidt, Ruth, Murray, Daniel D., Itenov, Theis, Bossios, Apostolos, Nielsen, Susanne Dam, Vestbo, Jorgen, Biering-Sorensen, Tor, Karsdal, Morten, Jensen, Jens-Ulrik, Sivapalan, Pradeesh, Kamstrup, Peter, Sand, Jannie Marie Bulow, Ulrik, Charlotte Suppli, Janner, Julie, Ronn, Christian Philip, Ronnow, Sarah Rank, Leeming, Diana Julie, Jensen, Sidse Graff, Wilcke, Torgny, Mathioudakis, Alexander G., Miravitlles, Marc, Lapperre, Therese, Bendstrup, Elisabeth, Frikke-Schmidt, Ruth, Murray, Daniel D., Itenov, Theis, Bossios, Apostolos, Nielsen, Susanne Dam, Vestbo, Jorgen, Biering-Sorensen, Tor, Karsdal, Morten, Jensen, Jens-Ulrik, and Sivapalan, Pradeesh
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Cardiovascular diseases are common in patients with chronic obstructive pulmonary disease (COPD). Clot formation and resolution secondary to systemic inflammation may be a part of the explanation. The aim was to determine whether biomarkers of clot formation (products of von Willebrand Factor formation and activation) and clot resolution (product of fibrin degeneration) during COPD exacerbation predicted major cardiovascular events (MACE). The cohort was based on clinical data and biobank plasma samples from a trial including patients admitted with an acute exacerbation of COPD (CORTICO-COP). Neo-epitope biomarkers of formation and the activation of von Willebrand factor (VWF-N and V-WFA, respectively) and cross-linked fibrin degradation (X-FIB) were assessed using ELISAs in EDTA plasma at the time of acute admission, and analyzed for time-to-first MACE within 36 months, using multivariable Cox proportional hazards models. In total, 299/318 participants had samples available for analysis. The risk of MACE for patients in the upper quartile of each biomarker versus the lower quartile was: X-FIB: HR 0.98 (95% CI 0.65-1.48), VWF-N: HR 1.56 (95% CI 1.07-2.27), and VWF-A: HR 0.78 (95% CI 0.52-1.16). Thus, in COPD patients with an acute exacerbation, VWF-N was associated with future MACE and warrants further studies in a larger population.
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- 2022
241. Pulmonologists’ Opinion on the Use of Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease Patients in Spain: A Cross-Sectional Survey
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Miravitlles,Marc, González-Torralba,Fernando, Represas-Represas,Cristina, Pomares,Xavier, Márquez-MartÃn,Eduardo, González,Cruz, Amado,Carlos, Forné,Carles, Alonso,Soledad, Alcázar,Bernardino, Barrecheguren,Miriam, Jurado Mirete,Juan MarÃa, Naval,Elsa, Miravitlles,Marc, González-Torralba,Fernando, Represas-Represas,Cristina, Pomares,Xavier, Márquez-MartÃn,Eduardo, González,Cruz, Amado,Carlos, Forné,Carles, Alonso,Soledad, Alcázar,Bernardino, Barrecheguren,Miriam, Jurado Mirete,Juan MarÃa, and Naval,Elsa
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Marc Miravitlles,1,2 Fernando González-Torralba,3 Cristina Represas-Represas,4 Xavier Pomares,2,5 Eduardo Márquez-MartÃn,2,6 Cruz González,7 Carlos Amado,8 Carles Forné,9,10 Soledad Alonso,11 Bernardino Alcázar,12 Miriam Barrecheguren,1 Juan MarÃa Jurado Mirete,13 Elsa Naval14 1Pneumology Department, Hospital Universitari Vall dâHebron, Vall dâHebron Institut de Recerca (VHIR), Vall dâHebron Barcelona Hospital Campus, Barcelona, Spain; 2CIBER de Enfermedades Respiratorias (CIBERES), ISCIII, Madrid, Spain; 3Pneumology Department, Hospital Universitario del Tajo, Aranjuez, Spain; 4Pneumology Department, Hospital Ãlvaro Cunqueiro, Vigo, Spain; 5Pneumology Department, Corporació Sanità ria Parc TaulÃ, Sabadell, Spain; 6Medical-Surgical Unit for Respiratory Diseases, Hospital Universitario Virgen del RocÃo, Sevilla, Spain; 7Pneumology Department, Hospital ClÃnico de Valencia, Valencia, Spain; 8Pneumology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain; 9Heorfy Consulting, Lleida, Spain; 10Basic Medical Sciences Department, University of Lleida, Lleida, Spain; 11Pneumology Department, Hospital Universitario de Torrejón, Torrejón de Ardoz, Spain; 12Pneumology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain; 13Scientific Department, GOC Health Consulting, Barcelona, Spain; 14Pneumology Department, Hospital Universitario de La Ribera, Alzira, SpainCorrespondence: Marc Miravitlles, Pneumology Department, Hospital Universitari Vall dâHebron, P. Vall dâHebron 119-129, Barcelona, 08035, Spain, Tel/Fax +34 932746083, Email marcm@separ.esIntroduction: Identifying the variables that guide decision-making in relation to the use of inhaled corticosteroids (ICS) can contribute to the appropriate use of these drugs. The objective of this study was to identify the clinical variables that physicians consider most relevant for prescribing or withdrawing ICS in COPD.Methods: A cross-sectional survey was conducted i
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- 2022
242. Patients with Chronic Obstructive Pulmonary Disease and Evidence of Eosinophilic Inflammation Experience Exacerbations Despite Receiving Maximal Inhaled Maintenance Therapy
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Chen,Stephanie, Miravitlles,Marc, Rhee,Chin Kook, Pavord,Ian D, Jones,Rupert, Carter,Victoria, Emmanuel,Benjamin, Alacqua,Marianna, Price,David B, Chen,Stephanie, Miravitlles,Marc, Rhee,Chin Kook, Pavord,Ian D, Jones,Rupert, Carter,Victoria, Emmanuel,Benjamin, Alacqua,Marianna, and Price,David B
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Stephanie Chen,1 Marc Miravitlles,2 Chin Kook Rhee,3 Ian D Pavord,4 Rupert Jones,5 Victoria Carter,6 Benjamin Emmanuel,1 Marianna Alacqua,7 David B Price6,8 1BioPharmaceuticals Medical, Respiratory & Immunology, AstraZeneca, Gaithersburg, MD, USA; 2Pneumology Department, Hospital Universitari Vall dâHebron, Vall dâHebron Institut de Recerca (VHIR), Vall dâHebron Barcelona Hospital Campus, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain; 3College of Medicine, Seoul St Maryâs Hospital, the Catholic University of Korea, Seoul, South Korea; 4Oxford Respiratory NIHR BRC, Nuffield Department of Medicine, University of Oxford, Oxford, UK; 5Faculty of Health, University of Plymouth, Plymouth, UK; 6Observational and Pragmatic Research Institute, Singapore, Singapore; 7BioPharmaceuticals Medical, Respiratory & Immunology, AstraZeneca, Cambridge, UK; 8Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UKCorrespondence: David B Price, Observational and Pragmatic Research Institute, 22 Sin Ming Lane, #06-76, Midview City, Singapore, 573969, Singapore, Tel +65 3105 1489, Email dprice@opri.sgBackground: Some patients with chronic obstructive pulmonary disease (COPD) experience frequent exacerbations despite maximal inhaled therapy (âtriple therapyâ), possibly leading to high health care resource utilization (HCRU).Aim: Describe characteristics, future HCRU, and mortality of patients with COPD who experience frequent exacerbations despite triple therapy; characterize individuals who may be candidates for biologic therapies.Methods: This descriptive observational study used primary care data of patients aged ⥠40 years in the United Kingdom receiving maintenance therapy for COPD who had ⥠1 year of data prior to index date and ⥠1 year of follow-up data. We described these patientsâ clinical and demographic characteristics, including blood eosinophil counts (BEC), pattern of exacerbation
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- 2022
243. A Pooled Analysis of Mortality in Patients with COPD Receiving Dual Bronchodilation with and without Additional Inhaled Corticosteroid
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Miravitlles,Marc, Verhamme,Katia, Calverley,Peter MA, Dreher,Michael, Bayer,Valentina, Gardev,Asparuh, de la Hoz,Alberto, Wedzicha,Jadwiga, Price,David, Miravitlles,Marc, Verhamme,Katia, Calverley,Peter MA, Dreher,Michael, Bayer,Valentina, Gardev,Asparuh, de la Hoz,Alberto, Wedzicha,Jadwiga, and Price,David
- Abstract
Marc Miravitlles,1 Katia Verhamme,2 Peter MA Calverley,3 Michael Dreher,4 Valentina Bayer,5 Asparuh Gardev,6 Alberto de la Hoz,6 Jadwiga Wedzicha,7 David Price8,9 1Pneumology Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute (VHIR), Vall d’Hebron Barcelona Hospital Campus, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain; 2Department of Medical Informatics, Erasmus MC, Rotterdam, the Netherlands; 3Clinical Science Centre, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK; 4Department of Pneumology and Intensive Care Medicine, University Hospital Aachen, Aachen, Germany; 5Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA; 6Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany; 7Head Respiratory Division, National Heart and Lung Institute, Imperial College London, London, UK; 8Observational and Pragmatic Research Institute, Singapore; 9Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UKCorrespondence: Marc Miravitlles, Pneumology Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute (VHIR), Vall d’Hebron Barcelona Hospital Campus, CIBER de Enfermedades Respiratorias (CIBERES), P° Vall d’Hebron 119-129, Barcelona, 08035, Spain, Email marcm@separ.esBackground: Recent studies report a lower mortality rate during treatment with long-acting muscarinic antagonist (LAMA)/long-acting β2-agonist (LABA)/inhaled corticosteroid (ICS) versus LAMA/LABA in patients with symptomatic chronic obstructive pulmonary disease (COPD) and a history of exacerbations.Objective: We compared time to all-cause mortality with LAMA/LABA versus LAMA/LABA/ICS in patients with mild-to-very-severe COPD and a predominantly low exacerbation risk.Methods: Data were pooled from six randomized controlled trials (TONADO 1/2, DYNAGITO, WI
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- 2022
244. The Impact of Chronic Bronchial Infection in COPD: A Proposal for Management
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Martinez-Garcia,Miguel Angel, Miravitlles,Marc, Martinez-Garcia,Miguel Angel, and Miravitlles,Marc
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Miguel Angel Martinez-Garcia,1,2 Marc Miravitlles2,3 1Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain; 2CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; 3Pneumology Department, Hospital Universitari Vall d´Hebron, Vall dâHebron Institut de Recerca (VHIR), Vall dâHebron Barcelona Hospital Campus, Barcelona, SpainCorrespondence: Marc Miravitlles, Pneumology Department, Vall dâHebron Barcelona Hospital Campus, P. Vall dâHebron 119-129, Barcelona, 08035, Spain, Tel +34932746083, Email marcm@separ.esAbstract: Up to 50% of patients with chronic obstructive pulmonary disease (COPD) in stable state may carry potentially pathogenic microorganisms (PPMs) in their airways. The presence of PPMs has been associated with increased symptoms, increased risk and severity of exacerbations, a faster decline in lung function and impairment in quality of life. Although some clinical trials have demonstrated a reduction in exacerbations in patients chronically treated with systemic antibiotics, particularly macrolides, the selection of patients was based on the previous frequency of exacerbations and not on the presence of PPMs in their airways. Therefore, unlike in bronchiectasis, there is a lack of evidence-based recommendations for assessment and treatment of the presence of PPMs in either single or repeated isolations in COPD. In this article, we propose that chronic bronchial infection (CBI) in COPD be defined as the isolation of the same PPM in at least three sputum samples separated by more than one month; we review the impact of CBI on the natural course of COPD and suggest a course of action in patients with a single isolation of a PPM or suspected CBI. Antibiotic treatment in stable COPD should be recommended based on four main criteria: a) the presence of comorbid bronchiectasis, b) the demonstration of a single or multiple isolation of the same PPM, c) the clinical impact of CBI on the pa
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- 2022
245. Diaphragmatic Movement at Rest and After Exertion: A Non-Invasive and Easy to Obtain Prognostic Marker in COPD
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Mekov,Evgeni, Yanev,Nikolay, Kurtelova,Nedelina, Mihalova,Teodora, Tsakova,Adelina, Yamakova,Yordanka, Miravitlles,Marc, Petkov,Rosen, Mekov,Evgeni, Yanev,Nikolay, Kurtelova,Nedelina, Mihalova,Teodora, Tsakova,Adelina, Yamakova,Yordanka, Miravitlles,Marc, and Petkov,Rosen
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Evgeni Mekov,1 Nikolay Yanev,2 Nedelina Kurtelova,2 Teodora Mihalova,2 Adelina Tsakova,3 Yordanka Yamakova,4 Marc Miravitlles,5 Rosen Petkov2 1Department of Occupational Diseases, Medical University Sofia, Sofia, Bulgaria; 2Department of Pulmonary Diseases, Medical University Sofia, Sofia, Bulgaria; 3Central Clinical Laboratory, Medical University Sofia, Sofia, Bulgaria; 4Department of Anesthesiology and Intensive Care, Medical University Sofia, Sofia, Bulgaria; 5Pneumology Department, Hospital Universitari Vall d´Hebron/Vall dâHebron Institut de Recerca (VHIR), Vall dâHebron Hospital Campus; CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, SpainCorrespondence: Marc Miravitlles, Pneumology Department, Hospital Universitari Vall d´Hebron, Pg. Vall dâHebron 119-129, Barcelona, 08035, Spain, Email marcm@separ.esIntroduction: Diaphragmatic dysfunction is common in patients with chronic obstructive pulmonary disease (COPD). This study aimed to assess the prognostic significance of impaired diaphragmatic movement at rest and after exercise.Methods: This was a prospective study of patients with stable COPD. Diaphragmatic movements were examined at rest and after a 6-minute walking test (6MWT) with a convex transducer with a frequency of 3.5-5-7.5 MHz. Maximal movement of the diaphragm was measured in both right and left diaphragm, and the side with higher amplitude was selected for further analysis. Measurements obtained were evaluated for their prognostic value for a composite endpoint of moderate and severe COPD exacerbations and death in 1 year time period was assessed. In addition, postbronchodilator spirometry, symptoms, quality of life, and demographic and clinical information were collected.Results: A total of 96 patients were analyzed (62.5% male, mean age 65.1 years (standard deviation (SD): 8.1), mean FEV1 (% predicted): 55.8%, SD: 18.3%, mean CAT: 15.6 units, SD: 9.2). Sixty-four patients (67%) presented the composite endpoint. In the multivaria
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- 2022
246. Long-Term Risk of Mortality Associated with Isolation of Pseudomonas aeruginosa in COPD: A Systematic Review and Meta-Analysis
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Martinez-GarcÃa,Miguel Angel, Rigau,David, Barrecheguren,Miriam, GarcÃa-Ortega,Alberto, Nuñez,Alexa, Oscullo Yepez,Grace, Miravitlles,Marc, Martinez-GarcÃa,Miguel Angel, Rigau,David, Barrecheguren,Miriam, GarcÃa-Ortega,Alberto, Nuñez,Alexa, Oscullo Yepez,Grace, and Miravitlles,Marc
- Abstract
Miguel Angel Martinez-GarcÃa,1,2 David Rigau,3 Miriam Barrecheguren,2,4 Alberto GarcÃa-Ortega,1 Alexa Nuñez,2,4 Grace Oscullo Yepez,1 Marc Miravitlles2,4 1Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain; 2CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; 3Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; 4Pneumology Department, Hospital Universitari Vall d´Hebron, Vall dâHebron Institut de Recerca (VHIR), Vall dâHebron Barcelona Hospital Campus, Barcelona, SpainCorrespondence: Marc Miravitlles, University Hospital Vall dâHebron, Department of Pneumology, Vall dâHebron Barcelona Hospital Campus, Pg Vall dâHebron 119-129, Barcelona, 08036, Spain, Email marcm@separ.esBackground: Chronic bronchial infection is frequent in chronic obstructive pulmonary disease (COPD), but the impact of the isolation of pathogenic bacteria, and in particular Pseudomonas aeruginosa (PA) in respiratory samples on the prognosis of COPD is unclear.Methods: We conducted a systematic review of prognostic studies including patients with isolation of PA in sputum in stable state or during exacerbations of COPD. The main outcomes were all-cause mortality, respiratory mortality, and number and severity of future exacerbations. Data were expressed as hazard ratio (HR) (95% confidence interval [CI]) whenever possible.Results: Of 2773 studies, eight were finally included (23,228 individuals). The mean age ranged from 65.5 to 73 years. Six studies reported data for all-cause mortality. The adjusted risk of death was almost double in patients with PA isolation (HR 1.95, 95% CI, 1.34 to 2.84; quality of evidence moderate). Patients with PA isolation showed a three times higher adjusted risk of readmission at 30 days after discharge (OR 3.60, 95% CI, 3.60 to 12.03, 1 study; quality of evidence very low), and more than double adjusted risk of death and hospitalization at two years (HR 2.80, 9
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- 2022
247. Inhaled Corticosteroid Use Among COPD Patients in Primary Care in Spain
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Miravitlles,Marc, Roman-RodrÃguez,Miguel, Ribera,Xavier, Ritz,John, Izquierdo,José Luis, Miravitlles,Marc, Roman-RodrÃguez,Miguel, Ribera,Xavier, Ritz,John, and Izquierdo,José Luis
- Abstract
Marc Miravitlles,1 Miguel Roman-Rodríguez,2,3 Xavier Ribera,4 John Ritz,5 José Luis Izquierdo6,7 On behalf of OPTI investigator’s group1Pneumology Department, Hospital Universitari Vall d´Hebron/Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain; 2Centro de Salud Dra. Teresa Pique, Mallorca, Spain; 3Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Mallorca, Spain; 4Boehringer Ingelheim España, Sant Cugat del Vallés, Barcelona, Spain; 5Syneos Health - Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA; 6Department of Medicine and Medical Specialties, Universidad de Alcalá, Madrid, Spain; 7Pneumology Department, Hospital Universitario de Guadalajara, Guadalajara, SpainCorrespondence: Marc Miravitlles, Pneumology Department, Hospital Universitari Vall d’Hebron, P. Vall d’Hebron 119-129, Barcelona, ES– 08035, Spain, Email marcm@separ.esPurpose: Inhaled corticosteroids (ICS) are frequently used to treat chronic obstructive pulmonary disease (COPD) outside the current recommendations. Our aim was to describe ICS use in COPD patients and to identify factors associated with ICS use among COPD patients treated within primary care in Spain.Patients and Methods: This was a cross-sectional, non-interventional and multicenter study of patients with COPD treated in primary care. Patient characteristics and exacerbations were described in terms of ICS use among the overall cohort, and among those with spirometry confirmed COPD (post-bronchodilator forced expiratory volume in 1 second [FEV1]/forced vital capacity [FVC] ratio < 70%). Multivariable logistic regression was used to identify factors associated with ICS use.Results: A total of 901 patients were included, of which 47.9% (n = 432) were treated with
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- 2022
248. Opinions and Attitudes of Pulmonologists About Augmentation Therapy in Patients with Alpha-1 Antitrypsin Deficiency. A Survey of the EARCO Group
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Greulich,Timm, Albert,Anna, Cassel,Werner, Boeselt,Tobias, Peychev,Erika, Klemmer,Andreas, Ferreira,Francini, Clarenbach,Christian, Torres-Duran,Maria L, Turner,Alice M, Miravitlles,Marc, Greulich,Timm, Albert,Anna, Cassel,Werner, Boeselt,Tobias, Peychev,Erika, Klemmer,Andreas, Ferreira,Francini, Clarenbach,Christian, Torres-Duran,Maria L, Turner,Alice M, and Miravitlles,Marc
- Abstract
Timm Greulich, 1,* Anna Albert, 1,* Werner Cassel, 2 Tobias Boeselt, 1 Erika Peychev, 1 Andreas Klemmer, 1 Francini Ferreira, 3 Christian Clarenbach, 4 Maria L Torres-Duran, 5, 6 Alice M Turner, 7 Marc Miravitlles 8 1University Medical Centre Giessen and Marburg, Philipps-University, Department of Medicine, Pulmonary and Critical Care Medicine, Member of the German Centre for Lung Research (DZL), Marburg, Germany; 2University Medical Centre Giessen and Marburg, Philipps-University, Department of Medicine, Pulmonary and Critical Care Medicine, Sleep Disorders Centre, Member of the German Centre for Lung Research (DZL), Marburg, Germany; 3Bioclever, Barcelona, Spain; 4Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland; 5Pneumology Department, Hospital Álvaro Cunqueiro, AS Vigo, Spain; 6Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Spain; 7Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Institute of Applied Health Research, University of Birmingham, Birmingham, UK; 8Pneumology Department, Hospital Universitari Vall d´Hebron/Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain*These authors contributed equally to this workCorrespondence: Marc MiravitllesPneumology Department, Vall d´Hebron Barcelona Hospital Campus, P. Vall d’Hebron 119-129, Barcelona, 08035, SpainTel/Fax +34 932746083Email marcm@separ.esBackground: Augmentation therapy (AT) is the only specific treatment licensed for patients with alpha-1 antitrypsin deficiency (AATD) associated lung disease. Since patients with severe AATD may have a very different prognosis and AT requires intravenous infusions for life, the decision to initiate AT may be challenging.Methods: This survey was conducted on 63 experts in AATD from 13 European countries about their opinions and attitudes reg
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- 2022
249. Opinions and Attitudes of Pulmonologists About Augmentation Therapy in Patients with Alpha-1 Antitrypsin Deficiency. A Survey of the EARCO Group
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Greulich, Timm; https://orcid.org/0000-0002-2368-3014, Albert, Anna, Cassel, Werner, Boeselt, Tobias, Peychev, Erika, Klemmer, Andreas, Ferreira, Francini, Clarenbach, Christian; https://orcid.org/0000-0003-2158-2321, Torres-Duran, Maria L, Turner, Alice M; https://orcid.org/0000-0002-5947-3254, Miravitlles, Marc; https://orcid.org/0000-0002-9850-9520, Greulich, Timm; https://orcid.org/0000-0002-2368-3014, Albert, Anna, Cassel, Werner, Boeselt, Tobias, Peychev, Erika, Klemmer, Andreas, Ferreira, Francini, Clarenbach, Christian; https://orcid.org/0000-0003-2158-2321, Torres-Duran, Maria L, Turner, Alice M; https://orcid.org/0000-0002-5947-3254, and Miravitlles, Marc; https://orcid.org/0000-0002-9850-9520
- Abstract
Background: Augmentation therapy (AT) is the only specific treatment licensed for patients with alpha-1 antitrypsin deficiency (AATD) associated lung disease. Since patients with severe AATD may have a very different prognosis and AT requires intravenous infusions for life, the decision to initiate AT may be challenging. Methods: This survey was conducted on 63 experts in AATD from 13 European countries about their opinions and attitudes regarding AT. Participants were asked to rank the importance of 11 identified factors related with the prescription of AT. In addition, each participant was asked to respond to the indication of AT for 30 out of 500 hypothetical cases developed with the combinations of the 11 factors. Each case was evaluated by 3 experts to check the concordance. Results: The variables that scored higher on preferences for initiating AT were AAT genotype (score 8.6 from a Likert scale 0-10 (SD: 1.7)), AATD serum level (8.2 (SD:2.4)) and FEV1 (%) decline (7.9 (SD:2.4)). Among the 500 different cases, there was an agreement in indication of AT among the 3 experts in 291 (58.2%). Regarding the variables associated with AT, it was indicated to 81.9% of Pi*ZZ, 52.4% of Pi*SZ and 9.8% of Pi*MZ (p < 0.0001). For Pi*ZZ patients, multivariate analysis identified younger age, reduced FEV1 (%), higher FEV1 decline and worse emphysema as significantly associated with prescription (AUC = 0.8114); for Pi*SZ variables were younger age, worse FEV1 (%) and worse emphysema (AUC = 0.7414); and for Pi*MZ younger age, worse DLCO (%), higher DLCO decline and dyspnea (AUC = 0.8387). Conclusion: There is a high variability in the criteria for prescription of AT among European experts. Most cases were recommended AT according to guidelines, but a significant number of patients with genotype Pi*SZ and almost 10% Pi*MZ were recommended to initiate AT despite the lack of evidence of efficacy in these genotypes. Keywords: EARCO; Europe; augmentation therapy; survey.
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- 2022
250. Genetic diagnosis of α1-antitrypsin deficiency using DNA from buccal swab and serum samples
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Belmonte, Irene, Barrecheguren, Miriam, Esquinas, Cristina, Rodríguez, Esther, Miravitlles, Marc, and Rodríguez-Frías, Francisco
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- 2017
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